Registration

Personal Impact Workshops

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Workshops

Location

Dates

Workshops

Portland, Oregon

Oct 11 - 13, 2019

None

Impact 1: Climb

Personal Information

Contact Information

Please be sure that the email address you provide is correct as we'll use that address to send you confirmation of your registration.

First Name

Last Name

Company

Address

City

State

Zip/Postal Code

Phone

FAX

Email

I do not have an email address.

Best Contact Method

Best Contact Time

Date of Birth

Gender

MaleFemale

Sponsor

The person who most influenced you to attend.

Payment Options

Tax Information

If you are registering for one or more seminars in Canada, your total will include GST.

Payment Option

$495 Regular Rate

$395 Early-Bird Rate

$295 Partial Payment

$195 Student Rate

$100 Partial Payment

Total Due

GST

Amount Paid

Financial Information

Cancellation Policy

You may request a full refund up until two days before the day of the seminar by contacting the office. You may also request a full refund at the end of the seminar on Sunday if you feel you have not received value from the seminar (again, you must request the refund before you leave the seminar). Otherwise, there are no refunds.

I have read and agree to the above cancellation policy.

Disclaimer

Disclaimer Notes

Please read this disclaimer carefully. You must agree to it before you may submit this registration.

Disclaimer

Foundations for Tomorrow, Inc. ("Foundations") presents self-development and personal growth seminars (collectively, the “Program”) founded upon research and techniques that are shared by many other similar or analogous organizations and that have benefited untold numbers of individuals over many years. Foundations is intended to teach you new tools and methods for building healthy relationships and break through old patterns of thoughts, feelings, and behaviors. Through a series of open and rigorous discussions, voluntary sharing of one's own experiences, and short exercises, Foundations provides an opportunity for you to examine your life, reflect on your happiness and or pain, seek answers to questions or issues that have followed you through life, set new goals and strengthen and improve your overall quality of life. Although most people find these exercises to be engaging, challenging and rewarding, some may find them to be difficult and unsettling. The Program is designed for people who clearly understand they are responsible for their own health and well-being before, during and after the Program. It is not therapeutic in design, intent or methodology and is not to be used as a substitute for medical treatment, psychotherapy or health program of any nature, regardless of what you may believe or have heard from anyone. We advise you that the Program leaders, staff and volunteers who assist at the Program are not accredited mental health professionals and there will not be any accredited mental health professionals in attendance (or if they are in attendance, they are not acting in any official capacity as an accredited mental health professionals).

As with any serious undertaking in life, you should take the time now to determine whether or not you are physically, mentally, and emotionally prepared to engage rigorously in the exercises.

While it is ultimately your own voluntary choice, Foundations STRONGLY RECOMMEND THAT YOU SHOULD NOT PARTICIPATE in the Program if you:

have a personal or family history of bi-polar affective disorder (manic-depressive disorder), schizophrenia, acute or chronic depression or other psychotic disorder, whether or not you or they are being or have ever been treated or hospitalized;

are or have in the past year considered or had ideas of suicide, self-harm or harm to another;

are currently in therapy and your therapist sees a health reason why you should not participate in the Program; or

are uncertain about your physical, mental or emotional ability to participate in the Program.

If you have not been feeling well or if you have been meaning to see a physician or a mental health professional, it is imperative that you consult with a licensed physician or accredited mental health professional prior to your participating in the Program. If you are currently in therapy, it is imperative that you check with your therapist to determine whether he/she sees a health reason why you should not participate in the Program. Upon request, Foundations will provide you with information required to enable you or your health care professional to make an informed decision about your participation.

Should you experience any physical, mental, or emotional discomfort which you consider to be out of the ordinary, you agree to inform a Foundations supervisor. You may, of course, withdraw from the program at any time. With this in mind, we ask that you agree to the following Release, Waiver, and Indemnification Agreement(the "Agreement") confirming your understandings as to the purpose, intent, and expectations of the program described above.

RELEASE, WAIVER, AND INDEMNIFICATION AGREEMENT

I hereby covenant and agree to indemnify and save harmless Foundations and its directors, officers, employees, agents, volunteers, successors, and assigns (collectively, the "releases") from and against any and all claims, damages, losses, injuries, liability, costs and expenses suffered or incurred by any of the Releases directly or indirectly, by reason of, as a result of, arising out of, or in connection with, my participation in this program and activities. I hereby further agree to release and forever discharge, acquit, and covenant not to commence litigation against any of the Releases for all actions, omissions, legal damages, or equitable relief of whatever kind, including without limitation, negligence by any of the Releases, arising out of my participation in this program and related activities. In the event that anyone on my behalf commences an action against any of the Releases, I hereby forfeit and waive any damages that may be awarded against any of the Releases. I further agree that any claim or suit of any nature against the Releases shall be governed by and construed in accordance with the laws of the applicable state or province without reference to conflict of law principles and that any such suit may only be brought in the courts of the applicable state or province. As liquidated damages, I hereby agree to reimburse the Releases all of their costs, expenses, and legal fees should I, or should anyone on my behalf, bring any action requiring any of the Releases to defend itself. Should any paragraph or part of this Agreement be deemed unenforceable, I hereby agree that any remaining parts shall remain in full force and effect. I hereby acknowledge and agree that no representations, warranties, or guarantees have been made by any of the Releases with respect to my achieving any objectives.

I have read the above notice, considered the consequences, consulted with my mental health professional if appropriate, and based thereon, believe that I am physically, mentally and emotionally able to participate in the FOUNDATIONS program.

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